Aims Neonatal infection is a rare, yet important cause of morbidity and mortality among newborns. The main challenges in managing suspected early-onset neonatal infection include diagnosing those infants at risk who require antibiotics, and the timely cessation of treatment in neonates who are not infected. Recent NICE guidelines (CG 149; Aug 2012) provided recommendations for the identification and management of early-onset neonatal infection. This study aimed to develop a tool to audit these NICE guidelines, and investigate whether current practice at a NICU complied with them.

Methods Data was collected prospectively from 26 neonates admitted over a two week period to the NICU for suspected early-onset infection. This data was then compared against eight NICE standards.

Results The results indicated very mixed compliance, with adherence to the guidelines ranging from 0% to 100%. The two areas where practice diverged from recommendations were the timing of repeat investigations; and the dosage and course length of empirical antibiotic treatment. However, the study also highlighted the challenges in auditing the recent NICE guidelines, indicating several standards for which compliance could not accurately be assessed. These included the timing of investigations, and the delay until initiation of antibiotic therapy.

Conclusion This audit successfully identified areas of clinical practice that could be improved, and recommended a review of local trust antibiotic policy. It also drew attention to the difficulty of auditing the recent NICE guidelines, and provides guidance on how to contend with these challenges.